What type of revision do I need? (Photo)

My breast have never looked even since I had my breast augmentation a year ago. Saline 550cc under the muscle. I am not happy with how they sit nor how one is larger than the other .will this require a lift ? If so what type of lift . The "larger" breast looks flat like a pan cake when I lay on my back as the smaller one looks round and Perky. I was told I did not need a lift at the time of my surgery.

Doctor Answers 9

What type of revision do I need?

Hi,
Thank you for your question and photos.
It  appears the implant is making its way out to the side making it appear flat when you lie down. This can be corrected by adding permanent sutures to the lateral edge of your capsule to keep the implant in place. This is a common issue with large implants. Implants are heavy and will stretch/push tissue in its path creating problems in appearance. Please wear supportive bras at ALL times to minimize this phenomenon (especially when you sleep). Hope this helps.
Best wishes and kind regards, 


Texas Plastic Surgeon
4.7 out of 5 stars 209 reviews

What type of revision do I need?

Hi, there.
In-person examination will be needed to give you a thorough assessment and meaningful recommendation.
Based on your photos, your implants have "settled" and there is bottoming down.
You may need need implant exchange, capsulorrahpy, and possible lift depending on your goal.
Please consult with a board-certified plastic surgeon.
Best regards.

Go on consultations for your revision surgery

Hi,

Thanks for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Having said that, you should go see some plastic surgeons and pay for their recommendations. Online consultants are not the appropriate source of information for you; your plastic surgeon should be your resource when it comes to these types of complex situations. Your anatomy, previous breast history, surgeries, genetics, examination and wishes all play MAJOR roles in how to manage this type of revision surgery.

Asking surgeons who do not have access to all of the above information is not fair to us. We would be providing you a disservice by guessing. Having several surgeons 'guessing' will only lead to you being even more confused because they may be influencing you incorrectly because they only have parts of the equation. If they were given all of the equation their answers may dramatically change.

These are your breasts and should not be managed by guesses, educated guesses or not, they are still guesses. Please take the time to invest in your breasts and go see several plastic surgeons, give them the entire story and then, you will get terrific advice.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

What type of revision do I need?

It appears that your breast implants have stretched out your breasts tissue/skin over the course of a year. You do not need a breast lift. The placement of capsulorrhaphy sutures within your pockets will help to improve symmetry and shape of your breasts, as well as the position of your breast implants especially when you lay on your back. Thank you for sharing your photos and concerns. Best wishes.

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 158 reviews

Breast revision

Your photos are kind of confusing as in some the right breast looks larger and other the left breast looks larger. But if the asymmetry bothers you then you would most likely need to add more water or get a larger implant on the smaller side. You may also have to lower the implant a bit on the smaller side because when it sits higher it tends to look smaller. 

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 88 reviews

Postop Asymmetry

Good afternoon!

Your "larger" side actually has some bottoming out, which makes it look larger. That side also has some lateral bottoming out when you lay down. All this indicates is that the pocket is way too large, allowing your implant to slide all around your chest wall depending on your position.

The other side is more or less normal.

I do have some ideas for your correction. If you want to keep it simple and just fix the bottomed out side, I would perform the Internal Bra on that side, my strong permanent internal suturing technique which corrects bottoming out and provides excellent long term support. This is actually the most common procedure I perform when patients come to see me for revisions, about 5-6 times a week.

If you would like an overall improvement to both sides, and asked me what would I do, then I would do the Internal Bra on both sides, exchange your implants for a little larger to give you better projection and definition, and I would consider a donut mastopexy to lift your nipple position and tighten your skin and make your areolas a little smaller.

I have attached a link to my Breast Augmentation Revision photo gallery for your review- hope it helps!

Breast Revision

From the photos you have the appearance of lower position of the breast implant with stretch of the bottom portion. I would recommend switching to a higher fill volume gel implant like a Sientra 107. An inferior capsulorraphy (tightening of the bottom capsule) with Strattice reinforcement would help this not recur. good luck

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Implant size and weight

Good morning!

Looking at your photos, you do appear to be somewhat bigger in the right breast.  You settling of your implant also appears to be normal for your tissue and size of implant.  It is important to remember that these implants have weight, and the bigger they are the heavier they are, and the heavier they are the more gravity is going to pull them downward.  As far as the lateral offset of your breasts while recumbent, it could be an issue with your lateral pocket being over dissected on that side- there is no way to tell without an exam.

If you were interested in a revision to make you perkier and keep your implants from sliding laterally when flat, pocket revision surgery can be performed to better tailor your pocket to your implant size. Your existing implant capsule that your body has formed can be used to make an "internal bra" to better support your implant.   Be sure and see a surgeon certified by the American Board of Plastic Surgery who does a lot of revision cosmetic plastic surgery.

I hope this helps

Robert Steely, MD, FACS
Houston Plastic Surgeon
4.8 out of 5 stars 51 reviews

Breast revision options

I'm not quite clear of your progression in the pictures.  But the 1yr post op pic is the common shape for 550cc saline implants.  Gravity, soft tissue relaxation is why they have settled since your original surgery. So you have a very natural result for your outcome.    If you want your implants high, and with full volume of the upper pole, then that is not a natural result. I'm sure you look great in a bra.  But if you want to look like that more in the nude, a higher profile, and/or larger, implant would likely give you more of that kind of result.  
Lastly, asymmetry is the normal.  Perfect symmetry is impossible. You were not born perfect, and any augmentation/lift will not make you perfect.  The pursuit for perfect symmetry will be frustrating, disappointing, and can actually make it worse in the long run. It appears that you may have slight volume and areola asymmetry.  Slight.   An exam would be ideal to give you a better recommendation.

Definitely make an in-person consultation with a PS to evaluate you and discuss your options.
Hope that helps and best wishes!
Dr Morales
Houston, Tx

Rolando Morales Jr, MD
Houston Plastic Surgeon
5.0 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.